Provider Demographics
NPI:1275795445
Name:THORNER, DANIEL ALEXANDER (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALEXANDER
Last Name:THORNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 RACQUET LN
Mailing Address - Street 2:STE 100
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-6114
Mailing Address - Country:US
Mailing Address - Phone:509-249-3900
Mailing Address - Fax:509-573-3324
Practice Address - Street 1:2500 RACQUET LN
Practice Address - Street 2:STE 100
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6114
Practice Address - Country:US
Practice Address - Phone:509-249-3900
Practice Address - Fax:509-573-3324
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60268813208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0295491OtherL&I
WA2017875Medicaid
WA0295491OtherL&I
WAG8912532Medicare PIN